脉搏血氧饱和度对丽江地区ARDS患者病情评估的可行性分析  

Feasibility of pulse oxygen saturation for the condition evaluation of acute respiratory distress syndrome patients in the Lijiang region

作　　者：杨潇[1] 刁璐 陈耀武 陈一峰 代冬梅[1] 肖李乐云[1] 王英[1] 许汪斌[1] Yang Xiao;Diao Lu;Chen Yaowu;Chen Yifeng;Dai Dongmei;Xiaoli Leyun;Wang Ying;Xu Wangbin(Department of Intensive Care Unit,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,Yunnan,China;Department of Emergency Medicine,People's Hospital of Lijiang,Lijiang 674100,Yunnan,China)

机构地区：[1]昆明医科大学第一附属医院重症医学科,云南昆明650032 [2]丽江市人民医院急救医学部,云南丽江674100

出　　处：《中华危重病急救医学》2021年第12期1447-1452,共6页Chinese Critical Care Medicine

基　　金：云南省昆明市科技计划项目(20201H052);昆明医科大学研究生创新基金(2020S166)。

摘　　要：目的探讨在丽江地区使用脉搏血氧饱和度(SpO_(2))对急性呼吸衰竭(ARDS)患者病情评估的可行性。方法选择2020年8月至12月丽江市人民医院急诊科就诊的ARDS患者作为研究对象。按病情严重程度将患者分为轻度ARDS组〔200 mmHg(1 mmHg=0.133 kPa)≤氧合指数(PaO_(2)/FiO_(2),P/F)≤300 mmHg〕和中重度ARDS组(P/F≤200 mmHg)。记录患者的一般情况、临床诊断、动脉血气分析结果,比较不同病情严重程度两组ARDS患者上述指标的差异。采用Spearman相关性分析法分析SpO_(2)与动脉血氧饱和度(SaO_(2))的相关性。将SpO_(2)带入Ellis方程式和Rice方程式中,计算出推导的P/F,分析推导的P/F与动脉血气分析中测量的实测P/F的相关性;绘制受试者工作特征曲线(ROC曲线),计算SpO_(2)/吸入氧浓度(SpO_(2)/FiO_(2),S/F)替代P/F评估ARDS患者氧合的敏感度和特异度;评价SpO_(2)对丽江地区ARDS患者病情评估的可行性。结果与轻度ARDS组比较,中重度ARDS组动脉血氧分压(PaO_(2))、SaO_(2)及血红蛋白(Hb)均明显降低〔PaO_(2)(mmHg):50.5(39.3,56.5)比60.0(55.0,67.5),SaO_(2):0.86(0.73,0.91)比0.93(0.90,0.96),Hbg/L:142±27比156±24,均P<0.05〕。相关性分析显示,高海拔地区ARDS患者的SpO_(2)与SaO_(2)呈显著正相关(R=0.650,P=0.000);用Rice公式推导出的P/F与动脉血气分析得出的P/F呈显著正相关(R=0.802,P=0.000);轻度ARDS组和中重度ARDS组推导出的P/F与实测P/F均呈显著正相关(R值分别为0.562和0.647,均P=0.000)。用Ellis公式推导出的P/F与动脉血气分析得出的P/F呈显著正相关(R=0.822,P=0.000);轻度ARDS组和中重度ARDS组推导出的P/F与实测P/F均呈正相关(R值分别为0.556和0.589,P值分别为0.000和0.010)。ARDS患者S/F与P/F呈显著正相关(R=0.828,P=0.000),回归方程为S/F=1.33 P/F+52.41。ROC曲线分析显示:S/F对轻度和中重度ARDS患者均有一定预测价值,ROC曲线下面积(AUC)和95%可信区间(95%CI)为0.903(0.829~0.977)、0.936(0.870~1.000),�Objective To explore the feasibility of using pulse oxygen saturation(SpO_(2))to evaluate the condition of patients with acute respiratory distress syndrome(ARDS)in the Lijiang region.Methods Patients with ARDS who visited the department of emergency of People's Hospital of Lijiang from August to December 2020 were selected as study subjects.Patients were divided by severity into mild ARDS group[200 mmHg(1mmHg=0.133 kPa)≤oxygenation index(PaO_(2)/FiO_(2),P/F)≤300 mmHg]and moderate to severe ARDS group(P/F≤200 mmHg).The general condition,clinical diagnosis,arterial blood gas analysis results of the patients were recorded,and the differences of the above indexes between the two groups of ARDS were compared.Spearman correlation analysis was used to analyze the correlation between SpO_(2) and arterial oxygen saturation(SaO_(2)).SpO_(2) was carried into the Ellis equation and the Rice equation to calculate the derived P/F and analyze the correlation between the derived P/F and the P/F measured in arterial blood gas analysis;receiver operator characteristic curve(ROC curves)were plotted,the sensitivity and specificity of SpO_(2)/fraction of inspiration oxygen(SpO_(2)/FiO_(2),S/F)instead of P/F to assess oxygenation in patients with ARDS was calculated.To evaluate the feasibility of SpO_(2) for the condition evaluation of patients with ARDS in the Lijiang region.Results Compared with the mild ARDS group,the arterial partial pressure of oxygen(PaO_(2)),SaO_(2) and hemoglobin(Hb)were significantly decreased in the moderate to severe ARDS group[PaO_(2)(mmHg):50.5(39.3,56.5)vs.60.0(55.0,67.5),SaO_(2):0.86(0.73,0.91)vs.0.93(0.90,0.96),Hb(g/L):142±27 vs.156±24,respectively,all P<0.05].Correlation analysis revealed a significant positive correlation between SpO_(2) and SaO_(2) in ARDS patients residing at high altitude(R=0.650,P=0.000).The P/F derived by the Rice formula was significantly and positively correlated with the P/F derived from arterial blood gas analysis(R=0.802,P=0.000).The deduced P/F in mild and moderat

关 键 词：急性呼吸窘迫综合征 动脉血氧分压 脉搏血氧饱和度 吸入氧浓度 动脉血气分析 急诊科 

分 类 号：R563.8[医药卫生—呼吸系统]